[TCT2008]冠脉注射阿昔单抗在直接PCI中的作用

发布于:2008-10-15 21:29

韩玮，医学博士，心内科主治医师，发表论文10余篇，主要从事心血管疾病介入治疗

Hanwei, attending physician in Cardiology department of the General Hospital of Chinese Armed Police Forces, doctor degree in PLA General Hospital. Be proficiency in transradial coronary artery disease interventional therapy, IVUS and Multi-slice computed tomography coronary artery imagination, published 14 articles and 3 books recent years.

冠脉注射阿昔单抗在直接PCI中的作用

Intracoronary Abciximab Efficacious in Primary PCI

（北京武警总医院韩玮翻译）

德国莱比锡大学Gerhard Schuler教授在TCT上发表的研究中指出，PCI术前冠脉内注射阿昔单抗和静脉注射该药物比较能改善心肌灌注、降低微血管堵塞和梗死面积，也有总体改善的临床预后的趋势。该研究比较154例PCI患者中冠脉注射阿昔单抗和静脉应用阿昔单抗的结果。

研究主要终点梗死面积采用延迟增强MRI成像，显示冠脉用药组有显著改善。研究的临床终点包括死亡、心肌梗死、新发充血性心力衰竭和TVR，冠脉用药组有改善的趋势(P=.06)。另外90min平均ST段回落(77% vs. 70%; P=.007)和完全ST段回落(64.9% vs. 49.3%; P=.03)也支持冠脉用药组更好。同样冠脉用药组微血管栓塞也更少，MRI梗死面积的结果也被CK 梗死面积测定证实。

所有患者PCI都取得成功，两组共有5例患者发生无复流，TIMI血流和TIMI 心肌灌注分级两组没有差异。研究中静脉组的71例和冠脉组的67例进入到最终的分析，基线变量无统计学差异。该研究入选的患者为12小时内的AMI、持续时间超过30min的心绞痛和ECG上ST段抬高。

（来源：www.tctmd.com）

Intracoronary Abciximab Efficacious in Primary PCI

By TCT Daily Staff

An intracoronary bolus of abciximab before PCI was associated with improvement in myocardial perfusion, reduction of microvascular obstruction and infarct size, and a trend toward overall improved clinical outcome compared with IV administration of the drug.

Gerhard Schuler, MD, of the University of Leipzig, Germany, presented results of a randomized trial that compared IV vs. intracoronary administration of abciximab in 154 patients undergoing PCI.
For the primary study endpoint of infarct size as measured by delayed-enhancement MRI, there was a "marked difference," favoring intracoronary administration.

For the combined clinical endpoint (death, MI, new congestive HF, and TVR), there was a trend toward a better result with intracoronary administration (P=.06), Schuler said.

In addition, mean ST-segment resolution (77% vs. 70%; P=.007) and complete ST-segment resolution (64.9% vs. 49.3%; P=.03) at 90 minutes favored the intracoronary administration group. Similarly, the extent of microvascular obstruction was also significantly smaller in the intracoronary group. MRI results were confirmed by measurements of CK infarct size.

PCI was successful in almost all patients; there was no reflow in five patients in the two groups combined. There was no difference between the two groups in TIMI flow or TIMI perfusion grade after PCI.

In the study, 71 in the IV group and 67 in the intracoronary group were available for final analysis. No differences in relevant variables were seen between the groups at baseline.

Patients with onset of symptoms of AMI within 12 hours, persistent angina lasting longer than 30 minutes, and ST-segment elevation on ECG were included.

Disclosures:

• Dr. Schuler reports no relevant conflicts of interest.